Tubo-ovarian abscess after tubal ligation.

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.

PIP: This paper presents the case of a 32-year-old woman who developed a tubo-ovarian abscess 7 years following tubal ligation via minilaparotomy. Symptoms experienced included pain, which was exacerbated by walking, and mild deep dyspareunia. Abdominal and pelvic examinations revealed pain in the left iliac fossa, cervical excitation tenderness, and an ill-defined left adnexal mass. Sonographic evaluation of the pelvis showed an irregularly shaped, cystic mass (8.0 x 4.5 x 5.3 cm) with thickened internal septations and solid parts. A left tubo-ovarian multilobulated complex mass adherent to the omentum and the pelvic side was found upon laparotomy. There was pus in the Pouch of Douglas, and the uterus was 10 weeks in size with symmetrical enlargement. The previously ligated right fallopian tube and the ovary were unremarkable. Management includes left adnexectomy, omental biopsy, and 5-day course of antibiotics against Staphylococcus aureus, which was cultured from the purulent material in the Pouch of Douglas. Tubo-ovarian abscess should be considered in diagnosing patients presenting symptoms of pelvic inflammatory disease.

Tubo-ovarian abscess after tubal ligation

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.

Tubo-ovarian abscess after tubal ligation

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.(AU)

Appendiceal disease in chronic pelvic pain

Pelvic pain is considered chronic when it present for more than six months. Chronic pelvic pain affects as many as 15 percent of women in the reproductive age group, leading to significant impairment of work and home activities. The causes of chronic pelvic pain can be either gynaecological or non-gynaecological. Gastrointestinal causes tend to be overlooked by gynaecologists and in particular the appendix which not often considered as a source of chronic pelvic pain. This paper presents a case series from the experience at the Peebles Hospital in the British Virgin Islands. Of 36 diagnostic laparoscopies performed between September 1992 and September 1997 for patients suffering from chronic pelvic pain there were 7 with appendiceal disease. Of the 7 appendices that were removed 4 showed histopathologic evidence of chronic disease. Pelvic inflammatory disease was the assessment in 3 patients and repeated courses of antibiotics had not resulted in clinical improvement. Four of the patients who had appendectomies have remained pain free since operation. Although appendiceal disease is not a common entity in chronic pelvic pain it is important that health care providers involved in the management of patients with chronic pain consider the appendix as a possible cause.(AU)

Vasopressin use in myomectomy a community hospital experience

Perivascular vasopressin as a haemostatic agent in myomectomy has recently been shown to be very useful in reducing the amount of bleeding during operation. The published data have, however, come from work done in university or large hospital settings. The aim of this case series was to establish that vasopressin can be used effectively in a small community hospital setting, to reduce the need for blood transfusion, especially in the small countries of the Caribbean where blood banking is not often available. Twenty-two patients were evaluated in this case series. Vasopressin 1 unit/ml solution was injected into the broad ligament posteriorly, inferior to the insertion of the ovarian ligament and anteriorly, inferior to the insertion of the round ligament. The drug was also injected along the line of of the incision in the myometrium. Of the twenty-two patients evaluated three were excluded, two because of degenerating fibroids while the other had adenomyosis. None of the nineteen patients required transfusion. The average blood loss was 240 ml; three patients had losses greater than 500 ml. Intraoperative changes in vital signs in these patients were minimal and no patient required reoperation because of post-operative haemorrhage. As has been reported previously, vasopressin can be used effectively as a haemostatic agent in myomectomy. The reduction in the need for blood transfusion in this community hospital setting is a major clinical advantage (AU)

Intravenous leiomyomatosis with massive ascites

A case of intravenous leiomyomatosis with massive ascites is reported. This is the first such recorded case. The patient was treated with a subtotal abdominal hysterectomy and bilateral salpingo-onphorectomy, pathological examination established a vessel wall origin. There is no evidence of recurrence up to 20 months after initial treatment.(AU)